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Safe and Sustainable
Children's Cardiac August 2009 Surgery Services News
Welcome to the first issue of "Safe and Sustainable" - the
stakeholder newsletter for all those with an interest in the
children's cardiac surgery services programme.
The aim of the programme is to ensure that the NHS delivers a high
quality, safe and sustainable heart surgery service for babies, children,
young people and their families. We all want world class care for the
children of this country, and especially those with life-threatening
heart conditions. This programme will ensure that this care remains the
best it can possibly be well into the future.
We want the surgeons who operate on our children and the teams
who support them to have the skills and experience that meet the
highest national and international standards.
In this newsletter we outline the aims and objectives of the programme
and we explain how we are going to develop the paediatric cardiac
surgery programme in England.We also explain how you can get
involved and feedback your views. Our new, national vision must be
created by patients and families, front line NHS staff, and the public all
working together.
To help inform the ongoing debate we will be holding a major discussion
event on 22 October 2009 in London - the first of a series that will take
place over the coming year. Details can be found on the back page.
I hope that you find this newsletter informative and I look forward to
hearing your views and seeing you in October.
Dr Patricia Hamilton
Director of Medical Education for England
Immediate Past President of the Royal College of Paediatrics and Child Health
Chair of the Steering Group for the Safe and Sustainable Paediatric
Cardiac Surgery Service Programme
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Background to the Safe
and Sustainable programme
This is called the Safe and Sustainable
programme, and its motivation is to deliver
the best possible care for children and their
families.
There are currently 11 children's heart surgery
centres in England. Approximately 30 surgeons
conduct children's heart operations in England
and between them they carry out around
3,800 procedures a year. This number is
unlikely to change significantly in the years to
come.
Children's heart surgery centres in England
currently provide a safe and high quality
service for children with heart problems. But
several current developments mean they will
need to evolve if they are to continue to
provide a top quality service into the future.
The Safe and Sustainable programme has
based its agenda on the following core
principles:
· the NHS must provide the very highest
standard of care for all children in England
who need heart surgery regardless of where
they live or which hospital provides their care
· the care that every centre provides must be
based around the needs of each child and
family, and take account of the transition to
adult services
· other than surgery and interventional
cardiology all relevant treatment (including
follow-up) must be provided as close as
possible to where each family lives
· we will develop a set of quality standards
and will ensure that services deliver the best
care by meeting these standards.
Over the past few years one particular view
has begun to emerge of how we might
reconfigure children's heart surgery centres to
address these principles and best meet the
needs of children and their families in the
future.
In summary this view involves creating largervolume
centres of excellence, increasing the
number of surgeons operating in each centre
and increasing the total volume of work that
each centre undertakes. This view is described
elsewhere in this newsletter in an article by
Leslie Hamilton, President of the Society of
Cardiothoracic Surgery of Great Britain and
Ireland.
The purpose of the Safe and Sustainable
programme is to canvass the opinions of all
stakeholders, to weigh the evidence for and
against different views and to deliver a safe,
sustainable and high quality service into the
future.
The NHS Management Board and the NHS Medical Director - Professor Sir Bruce
Keogh - have asked the National Specialised Commissioning Group (NSCG) to
examine the way that children's heart surgery services and interventional
cardiology services are provided in England. He has asked us to deliver a
sustainable service into the future.
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Programme who's who
The Safe and Sustainable programme is run by
a Steering Group that has been established by
the NSCG. The Steering Group is chaired by Dr
Patricia Hamilton, Director of Medical
Education for England and the Immediate Past
President of the Royal College of Paediatrics
and Child Health. Support for the Steering
Group is being provided by the National
Specialised Commissioning Team.
The Safe and Sustainable Steering Group is
supported by a Standards Working Group,
chaired by Mr William Brawn, a consultant
paediatric heart surgeon who works in the NHS.
The recommendations for future service
delivery will be developed by local
commissioners and health professionals, in
consultation with local stakeholders. Four
Specialised Commissioning Group (SCG)
collaboratives have been established to lead
on the process for delivering local
recommendations on behalf of all SCGs in their
zone (see table). The Steering Group will ensure
that the four proposals are consistent with each
other and consistent with the overall aims of
the Safe and Sustainable programme.
The Safe and Sustainable project team - comprising staff from the National Specialised
Commissioning Team - is detailed in the table below.
The programme project plan sets out a list of key milestones:
SCG Collaborative Member SCGs Lead SCG
Northern Zone North East, North West and North East SCG
Yorkshire & the Humber SCGs
Midlands Zone East Midlands and West Midlands SCGs East Midlands SCG
South Eastern Zone East of England, London London SCG
and South East Coast SCGs
South Western Zone South Central and South West SCGs South West SCG
Key milestones Date
Draft clinical standards circulated to stakeholders for comment Sep 2009
National stakeholder event in London Oct 2009
Final version of clinical standards circulated Nov 2009
SCGs submit recommendations for future service delivery Jul 2010
NHS Management Board considers the recommendations Jul 2010
Public consultation on the recommendations begins Sep 2010
Implementation of recommendations begins Jan 2011
(subject to the outcome of the consultation)
Steve Collins Deputy Director of Commissioning and Policy [email protected]
020 7932 3944
Jeremy Glyde Safe and Sustainable Programme Manager [email protected]
020 7932 3951
Andy Martin Safe and Sustainable [email protected]
Assistant Programme Manager 020 7932 3958
Stuart Pinel Safe and Sustainable Project Officer [email protected]
020 7932 3945
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In search of consensus
In this first issue of the Safe and Sustainable
newsletter Leslie Hamilton, the President of
the Society for Cardiothoracic Surgery of
Great Britain and Ireland and a member of the
Steering Group describes his personal search
for a consensus view on the future of
children's heart surgery services.
The NHS is continually changing and services
must change too if we are to provide the
highest quality care for patients into the
future. Over the past few years I believe a
consensus view has begun to emerge on the
best future shape of children's heart surgery
services in England.
This view involves a higher number of surgical
procedures being carried out by each clinical
team, with a larger number of surgeons in
each surgical centre, and a smaller number
of centres.
Critical mass
There is also a need to ensure that surgeons
conducting the enormously complex clinical
procedures involved in children's heart
surgery always have the experience and
expertise required to achieve consistently
excellent standards of care.
Many senior clinicians now believe there is a
direct correlation between the number of
surgical procedures carried out by a team of
surgeons and clinical outcomes - this has been
demonstrated in other specialties and recent
papers focussing on paediatric cardiac surgery
have confirmed this finding.
Sustainability
This emerging consensus viewenvisages a new
andmore sustainable configuration of services
supported by locally delivered, non-surgical
services - including follow-up appointments
- as close as possible to where the child lives.
Having a larger team of surgeons will allow
staged appointments at regular intervals giving
us the opportunity to develop a real team
approach. It will also allow for the mentoring of
newly appointed surgeons by more senior
colleagues in a supportive environment and on
a practical note, larger teams will help us do
away with excessively onerous on-call rotas.
I am convinced that working together as a team
is key to delivering good outcomes for patients
especially in the field of children's heart surgery.
Sub-specialisation
Throughout the developed world there is
currently a trend towards clinical subspecialisation.
This is widely deemed to be a
good thing because it is felt the more a
surgeon undertakes specific treatments, the
more honed his or her skills become.
Many clinicians argue that if a specialist centre
is to be able to treat the full range of
children's congenital heart conditions then
sub-specialisation means we will need a larger
number of sub-specialist consultants working
together in a single team in that centre.
Safe and Sustainable
Children's Cardiac Surgery Services News
Working hours
In addition the long working hours culture that
has been prevalent amongst clinicians over
many years is breaking down. Junior doctors
now work far fewer hours than they used to.
Younger doctors coming into the medical
profession are less likely to want to work
long hours. I also think we will increasingly
see consultant surgeons operating together.
This means we will need larger surgical teams
to ensure the provision of a sustainable, oncall
rota in each of our children's heart surgery
centres. Clinical expertise is currently spread
too thinly across the 11 English centres to
ensure long-term sustainability. Change must
happen now in the interests of our children.
History of the review
In 2006, Professor Roger Boyle, National
Director for Heart Disease and Stroke and
Dr Sheila Shribman, National Clinical
Director for Children, Young People and
Maternity Services chaired a workshop of
surgeons and cardiologists, other clinicians,
specialised services, commissioners and
parent/patient groups. In line with previous
reviews it concluded that the current service
configuration in England was not
sustainable and it reached the unanimous
view that we should aim for larger centres
of excellence and fewer of them.
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Support for the Safe and
Sustainable programme
The Children's Heart Federation (CHF) has announced its
support for the Safe and Sustainable programme for children's
heart surgery services in England.
CHF is the leading children's heart charity and the umbrella
body for voluntary organisations representing the needs
of children and young people with heart conditions and
their families.
Anne Keatley-Clarke, Chief
Executive of CHF, said: "Families
will feel more comfortable
knowing that a complex procedure such
as children's heart surgery is carried out
by a team of specialists that is doing
hundreds of these procedures a year.
Of course, parents want the very best
care for their children and they have
told us they are willing to travel
significant distances in order to get that
care. We fully support the Safe and
Sustainable programme and look
forward to working with the National
Specialised Commissioning Group to
ensure that every young child
who needs heart surgery
receives a world-class service."
And Professor Terence
Stephenson, President of Royal
College of Paediatrics and Child Health,
has added his support too. He said:
"The Royal College of Paediatrics and
Child Heath welcomes this review of
children's heart surgery services across
England. This is a very specialised area
of care and it is important that we have
the right number of specialist centres
offering the service with the right
training in place for tomorrow's
paediatric cardiac surgeons. The College
believes that this is in the best
interests of children and their
families."
"
"
"
"
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Have your say
The Safe and Sustainable programme team is keen to
hear from anyone who has views on the future delivery
of children's heart surgery services in England.
Please tell us your views. You can do so in the following ways:
·write to Jeremy Glyde, Programme Manager, National Specialised
Commissioning Team, 2nd floor, Southside, 105 Victoria Street,
London, SW1E 6QT.
·call Jeremy on 020 7932 3958
·e-mail: [email protected]
On 22 October 2009 we will be
holding a national event in London
for everyone who cares about the
future of children's heart surgery
services in England. You will have the
opportunity to discuss draft service
standards, to shape the work of the
programme and to agree on how we
take this important piece of work
forward. This event will be an
invaluable opportunity for parents
and carers, NHS staff, the public and
other stakeholders to help create the
world-class service of the future for
our children.
The event will take place at:
Dexter House
No.2 Royal Mint Court
Tower Hill
London
EC3N 4QN
Places are limited, so please confirm
your attendance as soon as possible
by:
·e-mailing
·calling Robin Matheou
on 020 7932 9122.
National stakeholder event
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